Provider Demographics
NPI:1770992497
Name:KLINGSMITH, TAMARA KAY (COTA)
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:KAY
Last Name:KLINGSMITH
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5022 CLARK LN APT 100
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65202-9983
Mailing Address - Country:US
Mailing Address - Phone:573-673-6991
Mailing Address - Fax:
Practice Address - Street 1:5022 CLARK LN APT 100
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65202-9983
Practice Address - Country:US
Practice Address - Phone:573-673-6991
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-06
Last Update Date:2014-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX212721224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant